I’m ok. Except when I’m not. A lot of big things have happened in the past 24 hours. I worked my last weekend at my internship. Saying goodbye to all the friends I have made is not an easy task. I got offered a job. A bigger salary job. A job I want to do. I think. A job in mental health. This means I am one step closer to having my license.
This means saying goodbye to my Early Intervention family which is even harder than I could even imagine. It is almost not worth the money just to keep the wonderful group of people I call my staff. But my passion is mental health and I have to pay back the education I’ve worked so hard for, so I hope they understand, and choose to always be in my life. I rode the fence but it is time I just dive in and see what life has in store!!!
And then there is graduation. Graduation. I graduated high school for my mom. I went to college for my mom. I’ll never forget her face that day. That same smile she gave each time she held one of her grandkids. Bubbling over full hearted smile. So Saturday will come and go…and I will not walk. I can’t. Not if I can’t see her smile. I worked hard. I earned it. But she’s not here to be proud of me.
And then there is Mother’s Day. The day I typically reserve for myself. To pamper myself. Eric and the kids go to Tennessee to see his mom and I walk around naked and binge watch tv all by myself. It’s the one day where there is no chaos. But this year I will spend Mother’s Day at the grave of the three strongest women I have ever known. And I won’t be ok.
Now I am completely afraid of being left alone. I have been busy. Really busy. If life slows down, I’m afraid I will break. I can’t break. This week is really heavy.
Well…I’m doing my internship. It’s going well. Except for the days I leave and want to call my mom. I want to hear her theories and crazy evaluations. I want to call Storm. I want her to tell me I shouldn’t be there. That I have a family to think of. That one of those folks is going to attack me and leave my kids without a mother. I want her to tell me I’ve wasted my education and all of my money because therapy is not a real thing and talking about things give them power…and I won’t argue with her. I will let her talk. I will listen to her and smile. That’s what you do with her when she turns into Negative Nancy…you listen and you smile.
And I realized today that I am about to be done. DONE. All of the years of school and three degrees. And my mom won’t be there to see it. A classmate was talking about graduation and I realized that I haven’t really even thought about it. I should go. I deserve to go. I’ve earned it…but I don’t want to walk if my mom isn’t there to see me. She is the reason I did all of this. To make her proud. To do what she wanted to do but never could. And to change my children’s world. Open doors. But mostly to make her proud.
Proud. And she would be. And she would tell everyone I had my PhD and got a job running a VERY important hospital and that I was going to make hundreds of thousands of dollars a year. She bragged like that. I will never know if she did it to let me know what she thought I was capable of or if she was really that delusional 😍 Either way…I miss it.
So I’m doing my internship…and then I’m done.
So…I have some social anxiety stuff. Jack has some social anxiety stuff. We don’t like talking to people and we don’t like people talking to us. And forget large crowds!!!! He started Kindergarten a few weeks ago and he had the ambitious goal of making a friend everyday. He got two friends and decided that was enough. But hey…he talked to other kids so I am proud!!
So I’m away at school and I decided that I need to change some things about myself. If Jack can do it…I can do it. I decided to make a friend a day. Yesterday I cheated a little. I re-engaged someone that was in a previous class with me. But I sought her out and made an effort to sit at her table during lunch.
Today was a little more difficult. I tried to work up the gumption to be social…but it just wasn’t firing. We split up into dyads and did role playing. My partner had “social anxiety”…Yes Kana, that’s your sign. So I made eye contact and talked with him after the exercise. He’s actually a little famous. I won’t disclose names but he has a shiny college bowl ring!!!
So tomorrow…I’m putting myself out on a limb and asking someone to be my study partner for the CPCE. The thought of being one on one with someone studying FREAKS ME OUT. But that’s what CBT is all about and I can’t ask clients to do something I wouldn’t do myself.
So, I’m working on a paper for school and something came to me that I feel the need to blog about. The 5th chapter of John tells the story of a man who can’t walk. He is sitting at a well in Bethesda where miracles happen…and he has been sitting there patiently for 38 years. Apparently he is waiting for someone to come and hand him the miracle of feeling. When Jesus asks him if he really wants to get well, the man tells Jesus that no one will help him get to the water. He also bitterly tells Jesus that when he tries to crawl to the well on his own…someone always steps in his way. The man was blaming his inability to get healing on outside forces instead of on his own self. Jesus tells him “Pick up your mat and walk”!!! At which point he does, and he is healed.
I wonder if that man laid there for 38 years afraid of what would happen if he ever DID make it to the water? He had gotten comfortable with where he was? Was he scared of feeling again, or was he scared that if he got there, he wouldn’t be healed? Did his fear of failure cause him to project blame on those around him? Either way, Jesus did not pamper the man. He simply told him to just do it – just get up and walk. The blaming and self-pity had been wasted energy. The time he had wasted on looking for reasons WHY he wasn’t healed could have been used getting himself to the water. Fear kept the man from being made whole. Jesus knew that, just like he knows our fears and doubts. He knows that we are human. He knows that we don’t like change.
I really don’t want to be the man waiting by the well for someone else to show me the way. I don’t want to be scared of change, something peculiar, something new. I’m ready to step out of my comfort zone and into something different. I don’t want to lay in wait for everyone else to move before I try to get what God has planned for me. I want to know what it feels like to move. That man wasted 38 years!!! I want to be able to say that I tried. I may get stepped on or I may drown in the water like a paralyzed fool, but I am not going to sit around and wonder what life could have been like if I wasn’t afraid to live…to feel.
There are almost 150 classes of drugs, all of which were primarily created to be used medicinally, “by changing the biological function of target cells through chemical actions (Doweiko, 2009, p. 18).” Pharmacology is the study of how these chemicals actions affect living organisms. It includes drug composition, interactions, therapeutic capabilities, and toxicology. Counselors in the addiction and rehabilitation field must have a working knowledge of all the components of pharmacology.
One of the most important parts of pharmacology is the route of administration for a drug compound, because this affects the intensity and speed of the drug’s action. According to Doweiko (2009), there are thirteen methods of administration, with primary routes including oral and injection. Oral administration has the longest effect time because it involves breakdown of the drug compound in the stomach and intestines before absorption into the blood stream. Because of this, some abusers prefer to crush pills meant for oral administration, and inhaling them intranasally. This method provides a faster effect time because it provides the drug direct access to the blood flow in the sinus cavity, but it is somewhat “erratic (Doweiko, 2009, p. 20).” Injection involves directly depositing the drug compound into a muscle, vein, or under the skin. One benefit of this method is an almost instant effect with no interference from the gastrointestinal tract (Doweiko, 2009).
The effective dose of a drug compound is the estimated amount of the drug needed to reach desired effects for a percentage of the population. The lethal dose is the estimated amount of the drug that would kill a percentage of the population. The therapeutic index measures the difference between the effective dose and a lethal dose. The lower the therapeutic index, the smaller the margin is between the compound being effective or becoming toxic.
According to Doweiko (2009), drug compounds “must enter the body in sufficient strength to achieve the desired effect (p. 21).” The prime effect of a drug compound is the therapeutic, or medical, benefit to a disease, illness, or condition (Doweiko, 2009). The secondary, or side effect, is the undesirable results of the drug compound. Peak effect indicates when the most powerful results of the drug compound are felt. The half-life of a drug compound is an approximation of the length of time it will remain active within the body. Generally, the faster the peak effect, the shorter the half-life of the drug (Doweiko, 2009).
The bioavailability of a drug compound describes how it is absorbed, distributed, broken down, and eliminated from the body. The process of moving the drug compound from the route of administration to the sight of action is absorption. The way the drug is moved throughout the body is distribution. Biotransformation is the detoxification, or breaking down the drug compound for elimination. Elimination is the process in which the human body purges itself of the drug compound (Doweiko, 2009).
When looking at the pharmacology of addiction, it is vital to look at all of the components of how a substance is introduced, processed, and eliminated from the human body. The faster a drug compound can be absorbed, allowing the user reach a high, the greater the risk of abuse and addiction by the user (Doweiko, 2009). Substance abuse counselors should be knowledgeable about the pharmacology of the drugs their clients abuse in order to understand the complex nature of addiction. They must know drug benefits, side effects, risks, and symptoms in order to be most effective.
Doweiko, H. (2009). Concepts of Chemical Dependency. (8th ed). Belmont, CA: Brooks/Cole Learning.
Models of addiction define theories behind why researchers believe a person becomes physically and/or emotionally dependent on substances. Even though it is a complex and often multi-layered battle, researchers have narrowed down the root causes of addiction (Cook, 2006). The three primary models presented by Doweiko in Concepts of Chemical Dependency (2009) are medical, psychosocial, and the disease of the human spirit.
The medical model views addiction as a disease or chronic illness, stating that people are biologically predisposed to become addicts (Doweiko, 2009). According to research, addicts have a lower number of dopamine receptors. Therefore, they are
biologically vulnerable to the effects of substances that cause the release of dopamine to flow properly to these receptors (Doweiko, 2009). Once exposed to the effects, these people have a more difficult time resisting abusing the substances (Cook, 2006). One risk of the medical model is that it creates an opportunity for addicts to avoid personal responsibility for their addiction
(Jenkins, 2011). It is still unknown whether generational abuse is a genetic pattern or a learned environmental behavior.
The psychosocial model suggests that addiction is a learned behavior of an addictive personality type (Doweiko, 2009). Theorists of this model do not believe addiction is a disease because the injured party contributes to and promotes the disorder, unlike other diseases (Dowieko, 2009). Instead, they propose that people who fall into a certain category of personalities become more vulnerable to social and environmental factors that lead to substance use and abuse (Cook, 2006). These factors cause the addictive personality to seek the relief of emotional pain through addiction. One downfall of the psychosocial model is that researchers are unable to agree on exactly what personality traits predict substance abuse and addiction (Doweiko, 2009).
The disease of the human spirit model suggests that lack of purpose and connection to a greater power lead to an unending void (Doweiko, 2009). According to this model, addicts have temporarily patched the void with the abuse of substances in order to escape reality. However, no amount of chemical use can permanently fill the spiritual and emotional void. God created humanity to be in relationship with him. Therefore, there is no outside substitute or fulfillment for the empty space that is created by living outside of a relationship with Him. People suffering from addiction become focused on the substance of their abuse. They lose sight of God. According to Doweiko (2009), “spiritual growth is impossible when people view chemical use as their first
When looking at the complex nature of the beast of addiction, it is important to take in account all of the factors involved and treat the person individually, and holistically. Counselors should look at the chemical, spiritual, biological, sociological, and psychological aspects in order to gain an accurate picture of each client. Therefore, it is my belief that it is vital to examine all three models of addiction to achieve the most effective treatment for therapy.
Cook, C. (2006). Alcohol, Addiction, and Christian Ethics. London: Cambridge University Press.
Doweiko, H. (2009). Concepts of Chemical Dependency. (8th ed). Belmont, CA: Brooks/Cole Learning.
Jenkins, D. (2011). Psy.D. Addiction and Recovery: Models of Addiction. (Video Presentation).
Abuse vs Addiction
SUBS505: Abuse and the Recovery Process
When discussing substance abuse, the terms “addiction” and “abuse” are often used interchangeably. Although substance abuse and substance addiction are both potentially hazardous, they are not the same. The difference between the two terms is subtle, but it is important to those seeking to understand the complex nature of substance dependency. Addiction is always caused by substance abuse. However, abuse does not always signify a substance addiction (Pinsky, 2003).
Substance abuse is the use of a substance for purposes other than it was intended to be used. Doweiko (2009) says that abuse is “using a drug with no legitimate medical need to do so, or in excess of accepted social standards (p.13).” In cases of abuse, there is not a physical dependence on the substance. The abuse may or may not have a negative impact on the personal life of the abuser, such as financial hardships and loss of relationships. However, many times the substance is either illegal, or is being used in an illegal manner (Pinsky, 2003). This may lead to legal struggles which open doors for financial, relational, or occupational problems.
Substance addiction begins when an individual has a physical or mental dependence on the substance they have been abusing (Pinsky, 2003). They begin to be preoccupied with the using and obtaining substance, neglecting obligations and ignoring social or personal problems caused by the use of the substance. Individuals who are suffering from addiction build up a tolerance and will go though withdrawal when they are denied use of the substance (Doweiko, 2009). These individuals will have financial, personal, and/or professional struggles due to the fact that they cannot stop the substance use in spite of the negative impact it has on their personal life. They may also suffer from legal issues stemming from their addiction (Pinsky, 2003).
When looking at the difference between the terms “abuse” and “addiction” there is a similarity, but also an obvious divergence. The impact of both on society is devastating. Doweiko (2009) says that the United States is responsible for over 60% of the worlds illicit drug use, and that alcoholism is the second most common clinical diagnosis. Substance abuse and addiction are becoming frequent topics of discussion in the media and the use of illegal substances has reached an all time high (Pinsky, 2009). Because of this, it is vital that professionals wishing to enter the field of rehabilitation counseling are properly trained and educated.
Doweiko, H. (2009). Concepts of Chemical Dependency. (8th ed). Belmont, CA:
Pinsky, D. (2003). Cracked:
Putting Broken Lives Together Again. New York: Regan Books.